Healthcare Provider Details

I. General information

NPI: 1932444221
Provider Name (Legal Business Name): PSIMED, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2012
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 UNIVERSITY AVE
MORGANTOWN WV
26505-3380
US

IV. Provider business mailing address

PO BOX 7310
CHARLESTON WV
25356-0310
US

V. Phone/Fax

Practice location:
  • Phone: 301-212-5526
  • Fax: 212-241-5162
Mailing address:
  • Phone: 304-344-8515
  • Fax: 304-344-8519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number23697
License Number StateWV

VIII. Authorized Official

Name: MR. TERRENCE EUGENE RUSIN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 304-344-8515